Association of foveal avascular zone with the metamorphopsia in epiretinal membrane.

This study was to investigate the relationship between the metamorphopsia and foveal avascular zone (FAZ) parameter in eyes with epiratinal membrane (ERM). We studied patients with an ERM visited retinal service unit at the Kagoshima University Hospital or Shirai Hospital. The best-corrected visual acuity (BCVA), and the degree of metamorphopsia by M -CHARTS™ were evaluated. The 3 × 3 mm optical coherence tomography angiography (OCTA) images of the superficial layer were obtained. Area (mm2), the circularity, eigen value were calculated using ImageJ software. The relationship between visual function, such as best corrected visual acuity (BCVA) and metamorphopsia, and FAZ parameters were studied by Pearson's correlational coefficient. Fifty-four eyes of 51 patients (24 men and 27 women) with an ERM were studied. The mean age of the patients was 69.6 ± 8.20 years. The mean BCVA and metamorphopsia score was 0.31 ± 0.29 logMAR units and 0.49 ± 0.42. There was no significant relationship between BCVA and FAZ parameters. While, metamorphopsia score was significantly and negatively correlated with all of FAZ parameters (area R = - 0.491, P < 0.001; circularity R = - 0.385, P = 0.004; eigenvalue ratio R = - 0.341; P = 0.012). Multiple regression analysis showed the FAZ area was solely and significantly correlated with metamorphopsia score (ß - 0.479, P < 0.001). The size but not the shape of the FAZ was significantly correlated with the degree of metamorphopsia suggesting that it could be an objective parameter of metamorphopsia in ERM patients.

Incidence of endophthalmitis and the perioperative practices of cataract surgery in Japan: Japanese Prospective Multicenter Study for Postoperative Endophthalmitis after Cataract Surgery.

PURPOSE: To prospectively survey the incidence of endophthalmitis following cataract surgery and investigate the current perioperative practices in Japan. METHODS: Patients who underwent cataract surgery from January 2012 to December 2013 were included. Information on perioperative practices were recorded prospectively. Clinical characteristics were examined in cases with endophthalmitis. RESULTS: A total of 63,244 patients who underwent cataract surgery in 205 facilities were enrolled. The detailed information about the current perioperative scenario surrounding cataract surgery in Japan was evaluated for the preoperative, intraoperative, and postoperative practices, i.e., patient background, prophylactic antibiotic regimen, modes of disinfection or disinfectant use, preoperative procedure, surgical method, surgical materials, surgical complication, or others. Postoperative endophthalmitis developed in 25 patients within 8 weeks postoperatively (incidence 0.04%). However, since outbreaks of toxic anterior segment syndrome (TASS) after implantation of intraocular lenses contaminated with aluminum (HOYA iSert 251 and 255) were reported, 10,261 cases implanted with the lenses had been excluded (as having a risk for non-infectious late-onset TASS). In the remaining 52,983 cases, postoperative endophthalmitis developed in 13 cases within 8 weeks postoperatively (incidence 0.025%). CONCLUSIONS: This prospective survey identified the current perioperative practices representing cataract surgery and the incidence of endophthalmitis following cataract surgery (0.025%) in Japan. We believe this information can serve as a guide for future improvement in risk-reduction strategies.

Correlation Between Recurrent Subconjunctival Hemorrhages and Conjunctivochalasis by Clinical Profile and Successful Surgical Outcome.

OBJECTIVE: To characterize the clinical profile of patients with recurrent subconjunctival hemorrhages (SCHs) and evaluate the effect of conjunctivochalasis (CCh) surgery on disease recurrences. METHODS: Three hundred and sixty-two patients with SCHs (mean age, 56.4±16.0 years) were enrolled in this multicenter epidemiologic study. The severity of CCh, lifestyle at the time of SCH onset, and the frequency of previous SCHs were compared. Thirty-eight patients with 2 or more episodes of SCHs (mean age, 68.2±8.9 years) underwent surgery for CCh. The effectiveness of surgery was evaluated by comparing the frequency of SCH preoperatively and postoperatively. RESULTS: Patients with three or more recurrent SCHs showed a significantly (P=0.003) higher grade of CCh and tended to be engaged in activities that require visual concentration, such as watching a visual display terminal, knitting, reading, and driving. More than 80% of eyes that underwent surgery to CCh showed no recurrence of the hemorrhages, and the frequency of SCH significantly (P<0.0001) decreased postoperatively. CONCLUSIONS: Moderate or severe CCh and activities that may cause dry eye can be considered to be risk factors for recurrent SCHs. Surgery to treat CCh is a useful option for patients with frequent recurrences of SCHs.

Miraflow, Soft Contact Lens Cleaner: Activity Against Acanthamoeba Spp.

OBJECTIVE: Miraflow is a cleaner for soft contact lens which contains 20% isopropyl alcohol. The purpose of this study was to determine the activity against Acanthamoeba trophozoites and cysts for Miraflow. In addition, to determine the activity of combined Miraflow and multipurpose solutions (MPSs) against Acanthamoeba cysts. METHODS: Two simulated-use studies were conducted. The significance in the log reduction in the number of trophozoites and cysts of A. castellanii strains ATCC 50514 and ATCC 50370 or A. polyphaga ATCC 30461 after exposure to Miraflow alone was determined by the Spearman-Karber method. To examine the activity against Acanthamoeba of combined Miraflow and an MPS, the log reduction in the number of cysts after a 1-min exposure to Miraflow followed by a 4-hr exposure to MPS (ReNu fresh) was also determined. RESULTS: Short-time exposure of 30 sec to Miraflow demonstrated activity against the Acanthamoeba trophozoites. However, a 1-min treatment was only relatively effective (1.1 log reduction) against the cysts of A. castellanii ATCC 50514, but no statistically significant reduction was observed for the cysts of the other 2 strains. The combined use with Miraflow and MPS demonstrated activity against the cysts, and a 3.0, 1.0, or 1.5 log reduction in the numbers was obtained for A. castellanii ATCC 50514, A. castellanii ATCC 50370, and A. polyphaga ATCC 30461, respectively. CONCLUSIONS: Exposure to combined Miraflow and MPS resulted in reductions in the number of Acanthamoeba cysts.

Evaluation of allergic conjunctivitis by thermography.

PURPOSE: To evaluate ocular surface temperature in assessing the efficacy of anti-allergic eye drops. METHODS: Thirteen asymptomatic patients (24.7 ± 2.8 years) with proven seasonal allergic conjunctivitis due to cedar pollen were studied. A 0.025% levocabastine ophthalmic suspension was instilled in one eye (levocabastine eye) and artificial tears in the other eye (artificial tear eye) in a masked fashion 10 min prior to a conjunctival allergen challenge (CAC). Then, a drop of cedar pollen solution was dropped into the conjunctival sac to induce the allergic reaction. The surface temperature of the inferior bulbar conjunctiva was measured before and 30 min after the CAC with a newly developed non-contact ocular surface thermographer (OST). The degree of conjunctival injection and chemosis was also determined by slit-lamp biomicroscopy. The changes in the symptoms were evaluated by a questionnaire. RESULTS: After the CAC, the temperature increased by 0.67 ± 0.10°C in the artificial tear eyes but by only 0.21 ± 0.06°C in the levocabastine eyes (p < 0.05). The score for conjunctival injection was 1.38 ± 0.24 and the chemosis score was 0.85 ± 0.25 for the artificial tear eyes and 0.62 ± 0.27 and 0.08 ± 0.08 in the levocabastine eyes (p < 0.01). The temperature increase was significantly correlated with the conjunctival injection scores (r = 0.63; p < 0.001). CONCLUSION: The significant correlation of the conjunctival surface temperature with the severity of the conjunctival allergic reaction indicates that the temperature measured by the OST can be used to objectively evaluate the efficacy of topical anti-allergic agents.

New side-view imaging technique for observing posterior chamber structures during cataract surgery in porcine eyes.

BACKGROUND: To develop a side-view imaging technique for observing the dynamic behavior of posterior chamber structures (PCSs) in porcine eyes which mimics closed-eye cataract surgery in humans. METHODS: Enucleated porcine eyes were placed into liquid nitrogen for 5 seconds and immediately bisected at about a 45-degree angle to the equatorial plane. The anterior portion was attached firmly to a glass slide with superglue and sprinkled with wheat flour. Phacoemulsification and aspiration (PEA) was performed as in humans on 10 consecutive porcine eyes. The movements of the PCSs were monitored through the glass slide with a high-resolution video camera set below the cut surface of the eye. The intraocular pressure (IOP) was monitored during the surgery. The highest IOP, operation time, and volume of irrigation fluid of 10 whole eyes were compared to that obtained from the bisected eyes glued to a glass slide. In a second set of experiments, the strength of the seal between the bisected eye and the glass slide was tested in three sets of eyes: 1) frozen eye fixed with superglue with wheat flour for 3 min; 2) frozen eye fixed with superglue for 3 min; and 3) non-frozen eye fixed with superglue for 30 min. The highest IOP that led to a disruption of the seal was compared among the three groups. RESULTS: PEA was successfully performed on 9 of 10 (90%) eyes with the movements of the PCSs clearly observed. The average maximum intraocular pressure of the 9 bisected eyes was 55.8 ± 4.7 mmHg and that for the 10 unbisected eyes was 55.3 ± 5.0 mmHg (P = 0.650). The frozen eye fixed with superglue in combination with wheat flour (Group 1) had the strongest sealing strength with an average IOP at the breaking point of 117.3 ± 36.2 mmHg. CONCLUSIONS: Our side-view imaging technique can be used to evaluate the changes of the PCSs during intraocular surgery and for surgical training of new residents.

Serrated Margins in Pseudomonas aeruginosa Keratitis.

PURPOSE: To describe 3 cases of culture-positive P. aeruginosa keratitis, who presented with a focus having serrated margins. METHODS: Observational case report. RESULTS: Three cases wearing contact lenses complained of symptoms such as pain, redness, and a decrease in vision. Slit-lamp biomicroscopic examination revealed a focus with serrated margins in all cases. The patients underwent corneal scraping for cultures, which confirmed the presence of P. aeruginosa. All 3 patients were treated with a combination of fluoroquinolone and tobramycin, 6-8 times per day. Corneal defects and infiltration disappeared within 2 weeks after initiating the therapy. CONCLUSION: Serrated margins may also be a characteristic initial presentation of P. aeruginosa keratitis.

Moxifloxacin as postoperative prophylaxis for Enterococcus faecalis-induced endophthalmitis after cataract surgery in aphakic rabbits.

PURPOSE: The development of endophthalmitis after cataract surgery often results in significant vision loss. Inhibition of bacterial proliferation in the anterior chamber using antibiotic eye drops is important to prevent endophthalmitis after cataract surgery. We aimed to determine the sensitivity of fluoroquinolones against Enterococcus faecalis ocular isolates and the efficacy of fluoroquinolones to prevent E. faecalis-induced endophthalmitis in aphakic rabbits. METHODS: The minimum inhibitory concentrations (MICs) of moxifloxacin (MFLX) and levofloxacin (LVFX) used in ophthalmic solutions for 13 E. faecalis isolates obtained from the conjunctival sac or endophthalmitis cases were determined. Eye drops containing MFLX (0.5%), LVFX (0.5%), or saline were administered to aphakic rabbits with endophthalmitis induced by E. faecalis. The eye drops were administered immediately after lensectomy and at 3 and 6 h after cataract surgery (early instillation group) or immediately after lensectomy and at 12 and 15 h after cataract surgery (delayed instillation group). Bacterial growth, electroretinography (ERG), and slit-lamp examination (SLE) were determined throughout the course of infection. RESULTS: In vitro susceptibility testing revealed that the MICs of MFLX for E. faecalis isolates were lower than those of LVFX. In the early ocular instillation groups, MFLX significantly improved SLE scores, ERG, and viable bacterial counts compared with LVFX and saline (all, P<0.05). There were no significant differences in any parameter between MFLX and saline in the delayed ocular instillation groups. CONCLUSIONS: Early ocular instillation of MFLX delays retinal damage compared with LVFX when used to treat E. faecalis-induced endophthalmitis after cataract surgery.

Antimicrobial efficacy tests of multipurpose contact lens care solutions simulating poor contact lens hygiene behaviors.

PURPOSE: The aim of this study was to simulate the biofilm formation in contact lens (CL) case under poor hygiene behaviors; antimicrobial efficacies of multipurpose solutions (MPSs) against biofilm on the lens case were evaluated. METHODS: Five MPSs (Epica Cold, Complete 10 min, ReNu MultiPlus, SoftOne Mois, and OPTI-FREE Plus) were tested. Lens cases containing ACUVUE2 were inoculated with 1×10, 10, or 10 colony-forming units (CFUs) of Staphylococcus epidermidis (SE). Each lens case was treated with 1 MPS for 4 hrs followed by the estimation of the number of SE by the CFU method. Disinfection efficacies of MPSs against SE biofilm were evaluated by biomicroscopy with safranin staining and scanning electron microscopy. RESULTS: Lens cases, inoculated with 1×10 CFU, were disinfected by all MPSs. Epica Cold, Complete 10 min, ReNu MultiPlus, and OPTI-FREE showed almost a 2-log reduction of the CFU, whereas SoftOne Mois effect was almost a 1 log reduction, significantly lower than other MPSs (P<0.05). No biofilm formations were observed in Epica Cold, Complete 10 min, ReNu MultiPlus, and OPTI-FREE Plus-treated groups unlike significant biofilm formation in the SoftOne Mois-treated group (P<0.01). CONCLUSIONS: Greater efforts to educate patients regarding compliant lens care behavior are needed to reduce the incidence of CL-associated microbial keratitis.

Effects of multipurpose contact lens care solutions on the adhesion of Acanthamoeba to silicone hydrogel contact lenses.

PURPOSE: To evaluate the effect of 7 multipurpose contact lens care solutions (MPSs) on the adhesion of Acanthamoeba (AC) to 5 silicone hydrogel contact lenses (SHCLs). METHODS: Acanthamoeba castellanii (ATCC50370) trophozoites were inoculated onto disks trimmed from SHCLs, Asmofilcon A, Galyfilcon A, Senofilcon A, Lotrafilcon B, and Balafilcon A. After 4-hour incubation, the number of adherent AC trophozoites on SHCL was counted under phase contrast microscopy. AC trophozoites mixed with 7 MPSs were inoculated onto Balafilcon A and incubated for 24 hours followed by direct counting, phase contrast microscopy, and scanning electron microscopy. AC cysts were also inoculated onto Balafilcon A followed by counting using phase contrast microscopy. RESULTS: Adhesion of AC trophozoites to Lotrafilcon B and Balafilcon A was 10 times higher in comparison with the other 3 SHCLs. Twenty four-hour treatment of AC trophozoites with Epica Cold, Epica Cold Aquamore, ReNu MultiPlus, OptiFree Plus, and Complete DoubleMoist reduced the numbers of adherent AC to less than 25% of control, whereas the numbers of AC treated with Complete AminoMoist and C3 SoftOne Moist was about 50% and 75% of control, respectively. Normal AC trophozoites without any treatments showed 25 times higher adhesion rates compared with normal AC cysts. CONCLUSIONS: The adhesion rates of AC trophozoites to SHCL varied depending on the type of MPSs used. Appropriate uses of MPS could reduce adhesion rates of AC to SHCL and potentially decrease clinical rates of Acanthamoeba keratitis.

Comparison of corneal and aqueous humor penetration of moxifloxacin, gatifloxacin and levofloxacin during keratoplasty.

INTRODUCTION: Achieving high antibiotic concentrations is important for preventing and treating postoperative infections. However, no study has simultaneously compared the achieved concentrations of moxifloxacin, gatifloxacin, and levofloxacin in the human cornea and aqueous humor. The authors therefore performed a randomized study to determine the concentrations of 0.5% moxifloxacin, 0.3% gatifloxacin, and 0.5% levofloxacin in the corneal tissue and aqueous humor after topical instillation in patients undergoing penetrating keratoplasty. METHODS: Patients who required penetrating keratoplasty were eligible for this study. The topical preparations of 0.5% moxifloxacin, 0.3% gatifloxacin, and 0.5% levofloxacin used in the study were preservative free (Japanese formulations). Patients were randomly assigned to one of three sequential drug groups, in which each drug was administered three times before surgery. In each administration cycle, the patients received two drops of each drug at 2-minute intervals. Samples of corneal tissue and aqueous humor were collected during surgery. The concentrations of each drug in the samples were determined by high-performance liquid chromatography. RESULTS: A total of 63 patients across eight centers in Japan were enrolled in the study. Overall, 61 corneal and 58 aqueous humor samples were evaluated. The concentration (mean±standard deviation) of moxifloxacin in corneal tissues was 12.66±8.93 µg/g, which was significantly higher than that of gatifloxacin (4.71±3.39 µg/g; P<0.0001) and levofloxacin (5.95±4.02 µg/g; P<0.0001). The mean concentration of moxifloxacin in aqueous humor samples was 1.40±1.17 µg/mL, which was significantly higher than that of gatifloxacin (0.65±0.80 µg/mL; P=0.0001) and levofloxacin (0.89±0.86 µg/mL; P<0.05). The sequence of drug administration did not significantly affect the results. CONCLUSION: These results show that 0.5% moxifloxacin achieved superior ocular concentration than both 0.3% gatifloxacin and 0.5% levofloxacin.

Efficacy of commercial soft contact lens disinfectant solutions against Acanthamoeba.

PURPOSE: To investigate the relative efficacy of Japanese commercial soft contact lens disinfectant solutions against Acanthamoeba trophozoites and cysts. MATERIALS AND METHODS: Eight types of multipurpose solution (MPS), two types of hydrogen peroxide solution, and one povidone-iodine solution were evaluated to determine their effect against Acanthamoeba trophozoites and cysts (ATCC 50514). Acanthamoeba cysts were cultured in encystment medium for either 1 or 2 weeks (1 and 2-week-old cysts). The trophozoites and cysts were treated with each disinfectant solution for 0, 2, 4, 8, or 24 h. After performing four tenfold serial dilutions of each test solution, dilutions were cultured for 10 days. The number of surviving organisms was calculated using the trimmed Spearman-Karber method. RESULTS: Among the MPS tested, only four were effective against trophozoites after treatment for 4 h, and none was effective against 2-week-old cysts. Hydrogen peroxide had a significant effect on trophozoites and 1-week-old cysts, but not on 2-week-old cysts. In contrast, povidone-iodine caused a 2.6 log reduction in 2-week-old cysts. CONCLUSIONS: MPS were found to have limited efficacy against trophozoites and no efficacy against 2-week-old cysts. Only povidone-iodine had any efficacy against 2-week-old cysts.

Influence of elevated intraocular pressure on the posterior chamber-anterior hyaloid membrane barrier during cataract operations.

OBJECTIVE: To investigate the influence of elevated intraocular pressure on the posterior chamber-anterior hyaloid membrane (PC-AHM) barrier during cataract operations in ex vivo porcine eyes. METHODS: A pressure transducer was connected to porcine eye anterior chambers (ACs). In experiment 1, ACs were perfused for 20 seconds with balanced salt solution containing 1.0-µm fluorescein beads (10 eyes per bottle height: 45, 85, 145, and 285 cm). In experiment 2, 5 ophthalmic viscosurgical devices with different molecular weights and sodium hyaluronate concentrations were infused into the ACs (20 eyes per ophthalmic viscosurgical device). After continuous curvilinear capsulorrhexis, hydrodissection was performed. After both experiments, PC-AHM barrier staining was evaluated through the Miyake-Apple view. RESULTS: Types of fluorescein staining patterns were classified as AC, zonule of Zinn, AHM, AHM tear, and ruptured capsule. In experiment 1, plateau intraocular pressure and staining type were positively correlated (Spearman rank correlation; r = 0.703, P < .001). In experiment 2, mean peak intraocular pressure was significantly greater in the ruptured capsule-type eyes than in the AC-, zonule of Zinn-, AHM (P < .001), or AHM-tear-(P = .02) type eyes, as well as in the AHM- and AHM-tear-type eyes compared with the AC and zonule of Zinn type eyes (P < .001). Intraocular pressure was significantly higher in eyes infused with ophthalmic viscosurgical devices with a higher molecular weight or sodium hyaluronate concentration (P < .05). CONCLUSIONS: Stress on the PC-AHM barrier increases as intraocular pressure increases. Ophthalmic viscosurgical devices with a higher molecular weight or sodium hyaluronate concentration might induce increased IOP during cataract operations. CLINICAL RELEVANCE: To maintain normal PC-AHM barrier function, excessive intraocular pressure should be avoided during cataract operations.

[Survey of severe contact lens-associated microbial keratitis in Japan].

PURPOSE: To understand the current state of severe contact lens (CL)-associated microbial keratitis in Japan. METHOD: The survey was conducted by the Japan Contact Lens Society and the Japanese Association for Ocular Infection in 224 facilities from April 2007 to March 2009. Patients who were diagnosed with CL-associated microbial keratitis and hospitalized for treatment were enrolled. Clinical characteristics of the keratitis, microbiologic findings and the status of CL hygiene were studied. RESULTS: A total of 350 patients were investigated, with an average age of 28.0 (9-90) years. Acanthamoeba was identified in 85 (24.3%) corneal specimens and Pseudomonus aeruginosa in 70 (20.0%) cases. One hundred ninety six (56.0%) patients were frequent replacement soft CL users. Extended wearing of daily-use CLs was found in 77 (22.0%) patients. Only 67 cases maintained good CL hygiene by daily rubbing-washing and the poor CL care situation was reviewed. CONCLUSION: The most frequently detected pathogenic microorganism was Acanthamoeba, followed by Pseudomonus aeruginosa. Our survey showed the importance of keeping good CL hygiene by proper lens care, and improvement of CL-related social regulations is urgently needed.

[Sustained effects of sodium hyaluronate solution on tear film stability evaluated by Tear Stability Analysis System].

PURPOSE: To investigate the sustained effects of sodium hyaluronate solution (HA) on tear film stability using a Tear Stability Analysis System (TSAS), a method enabling quantitative evaluation of tear film stability. METHODS: Eighteen eyes of 18 normal subjects (N group) and 21 eyes of 21 dry eye patients (D group) were examined. Dry eye was diagnosed by the 2006 diagnostic criteria. In each subject, artificial tears (AT), 0.1% sodium hyaluronate solution (H 01) or 0.3% sodium hyaluronate solution (H 03) were instilled into both eyes, and tear film stability in the right eye before and 1, 5, 15, 30, 60 and 120 minutes after instillation was compared using a break up index (BUI: 0-100), the TSAS's index of tear film stability. RESULTS: N group: In both the AT and H 01 subgroups, no significant change was found in the BUI ratios (BUI after instillation/before instillation) at any point during the 120 minute period after instillation. However, in the H 03 subgroup, the BUI ratio temporarily decreased to 0.650 one minute after H 03 instillation (p = 0.0038). D group: In the AT subgroup, the BUI ratio significantly increased to 1.568 five minutes after AT instillation (p = 0.0259), but began to decrease 15 minutes after instillation and returned to the initial value 30 minutes after instillation. In the H 01 subgroup, the BUI ratio significantly increased to 1.531 five minutes after H 01 instillation (p = 0.0087), and was maintained at 1.347 120 minutes after instillation (p = 0.0088). In the H 03 subgroup, the BUI ratio rose to 1.544 15 minutes after H 03 instillation (p = 0.0009), and was maintained at high levels of 1.413 30 minutes after (p = 0.0122), 1.629 60 minutes after (p = 0.0008), and 1.407 120 minutes after instillation (p = 0.0008). CONCLUSION: The current study confirms that both 0.1 and 0.3% sodium hyaluronate solution effectively improve tear film stability in dry eyes for up to two hours after instillation.

In vivo confocal microscopic evidence of keratopathy in patients with pseudoexfoliation syndrome.

PURPOSE: To measure the density of cells in different layers of the cornea and to determine whether morphologic changes of the subbasal corneal nerve plexus are present in eyes with the pseudoexfoliation (PEX) syndrome. METHODS: Twenty-seven patients with unilateral PEX syndrome and 27 normal controls were investigated. All eyes underwent corneal sensitivity measurements with an esthesiometer and in vivo confocal microscopic study. Densities of the epithelial, stromal, and endothelial cells were measured. The density and tortuosity of the subbasal corneal nerve plexus were also evaluated. RESULTS: Eyes with PEX syndrome had significantly lower cell densities in the basal epithelium (P = 0.003), anterior stroma (P = 0.007), intermediate stroma (P = 0.009), posterior stroma (P = 0.012), and endothelium (P < 0.0001) than in the corresponding layers of normal eyes. PEX eyes also had lower subbasal nerve densities and greater tortuosity of the nerves than normal eyes. Fellow eyes of patients with PEX also had significantly lower densities of the basal epithelial and endothelial cells than the normal eyes. Corneal sensitivity was significantly decreased in PEX eyes, and this was significantly correlated with the decrease of basal epithelial cell and subbasal nerve densities. CONCLUSIONS: These results have shed light on understanding of the pathogenesis of decreased corneal sensitivity in eyes with PEX syndrome. PEX syndrome is probably a binocular condition for which keratopathy of the fellow eye also requires observation.

Effectiveness of in vivo confocal microscopy in detecting filamentous fungi during clinical course of fungal keratitis.

PURPOSE: To determine the effectiveness of laser confocal microscopy in detecting filamentous fungi in the cornea of patients with fungal keratitis (FK) and in evaluating the effectiveness of the treatment. METHODS: The corneas of 6 patients clinically diagnosed with FK were examined with the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRT II-RCM). Three of these patients were also monitored periodically with the HRT II-RCM after antifungal treatment. RESULTS: The HRT II-RCM examination showed interlocking and branching, white, septated, hyphae-like lines in the cornea of all patients. All 6 patients had positive corneal smears and/or laboratory cultures. Three patients were monitored with HRT II-RCM after antifungal treatment. One patient, whose initial smear was negative, was diagnosed by HRT II-RCM before the positive culture results. In another case, the epithelial regeneration was impaired even 3 weeks after the initial treatment and HRT II-RCM revealed a mass of hyphae in the corneal ulcerated lesion. These findings indicated the necessity of surgical debridement. After the surgical debridement, the corneal epithelial defect was healed. HRT II-RCM was able to detect the morphological changes of hyphae after antifungal treatment and helped in the treatment modifications during the clinical course in all 3 patients. CONCLUSIONS: These results indicate that HRT II-RCM can be used to diagnose FK and to monitor the effect of therapy on FK.